Vertically expandable intervertebral cage, deployment device, and methods of using

ABSTRACT

A vertically expandable intervertebral cage, deployment devices, and methods for using the same. The intervertebral cage can include a circuitous body at least partially enclosing an interior volume. The intervertebral cage can also include a front panel which can be formed into a wedge for facilitating implantation of the intervertebral cage into an intervertebral space. The intervertebral cage can be converted from an undeployed configuration, wherein the height of the intervertebral cage is reduced, to a deployed configuration, wherein the height of the intervertebral cage is increased to support end plates of the vertebrae. The intervertebral cage can be converted from the undeployed configuration to a deployed configuration by using a deployment device such as an implantation device and a guide wire. The deployment device can be used to impart a force upon the cage.

RELATED APPLICATIONS

The present application is a continuation application of U.S. patentapplication Ser. No. 14/773,368, filed Feb. 26, 2015, which is a nationa stage application under 35 U.S.C. 371 of PCT Application No.PCT/US2014/018772, filed Feb. 26, 2014, which claims priority to U.S.Provisional Application No. 61/778,220 filed Mar. 12, 2013, titledVERTICALLY EXPANDABLE INTERVERTEBRAL CAGE, the entire contents of eachare hereby expressly incorporated by reference.

BACKGROUND Field

The present application relates to the field of spinal treatmentdevices, systems and methods, and more specifically, to intervertebralspinal implants and methods of using the same.

Background

Current intervertebral devices are designed using three majorprinciples: the anatomical limitations of the surgical approach,optimization of bone graft volume to promote bone fusion, andoptimization of the device contact with vertebral end plates to resistsubsidence. Many current devices are generally static in that theycannot change shape or volume. Thus, many current devices are limited byanatomy and technique and consequently may not provide optimal bonegraft volume or surface contact.

Other current intervertebral devices can change their shape and volume;however, these devices lack rigid components. As a result of this, whilethese devices are able to change their shape and/or volume, thesedevices do not provide for stable contact with vertebral end plates.Accordingly, there is a need for intervertebral devices which can changetheir shape and volume while providing stable contact with vertebral endplates.

SUMMARY

Certain embodiments of the present application relate to intervertebralimplants and methods of using the same. Some embodiments relate to anintervertebral cage that can be configured for positioning between twovertebrae and specifically between two vertebral end plates. In someembodiments, the intervertebral cage can be configured for expansiongenerally orthogonal to the vertebral end plates. That is, theintervertebral cage can be expandable at least a direction towards avertebral end plate. In some embodiments, the intervertebral cage canalso be configured for expansion generally parallel to the vertebral endplates.

In some embodiments, the intervertebral cage can include a circuitousbody at least partially enclosing an interior volume. The circuitousbody can include a top panel having a distal edge and at least two sideedges, a bottom panel having a distal edge and at least two side edges,and at least two side panels, each having a top edge and a bottom edge.The side panel may include at least one hinge dividing the side panelinto at least two side panel sections. The top edges of the side panelsmay be rotatably attached to the side edges of the top panel along ahinge. The bottom edges of the side panels may be rotatably attached tothe side edges of the bottom panel along a hinge. In some embodiments,the intervertebral cage can include a front panel having a top edge anda bottom edge, wherein the front panel additionally comprises at leastone hinge dividing the front panel into at least two front panelsections. The top edge of the front panel may be rotatably attached tothe distal edge of the top panel and the bottom edge of the front panelmay be rotatably attached to the distal edge of the bottom panel. Insome embodiments, in a first position, the top panel and bottom panelcan be separated by a first distance and the front panel can form aleading wedge. In some embodiments, in a second position, the top paneland bottom panel can be separated by a second distance, the seconddistance being greater than the first distance.

In some embodiments, the intervertebral cage can include a circuitousbody which can include a plurality of panels partially enclosing aninterior volume, the plurality of panels including at least a top panel,a bottom panel, and two side panels, wherein each of the panels of theplurality of panels are rotatably attached to adjacent panels alonghinges. In some embodiments, the intervertebral cage can also include afront panel having a first front panel section rotatably attached to asecond front panel section, the front panel being rotatably attached toat least two panels of the plurality of panels of the circuitous body.In some embodiments, in a first position, a distal-most part of thefront panel protrudes distally from the circuitous body. In someembodiments, in a second position, the distal-most part of the frontpanel protrudes less distally from the circuitous body.

Some embodiments relate to methods of using an expandable intervertebralcage. In some embodiments, the method can include positioning theintervertebral cage in the intervertebral disc space, wherein theintervertebral cage is configured to be moved from a first position to asecond position and wherein the intervertebral cage comprises acircuitous body and a front panel, forming a wedge with the front paneland applying a force on one or more panels of the intervertebral cage.In some embodiments, the circuitous body can include a plurality ofpanels.

Some embodiments relate to intervertebral cage systems. In someembodiments, the system can include an intervertebral cage which caninclude a circuitous body having a plurality of panels partiallyenclosing an interior volume. The plurality of panels can include atleast a top panel, a bottom panel, and two side panels. Each of thepanels of the plurality of panels can be rotatably attached to adjacentpanels along hinges. In some embodiments, the intervertebral cage of thesystem can include a front panel having a first front panel sectionrotatably attached to a second front panel section. The front panel canbe rotatably attached to at least two panels of the plurality of panelsof the circuitous body. In some embodiments, the intervertebral cage canbe configured so that, in a first position, a distal-most part of thefront panel protrudes distally from the circuitous body. In someembodiments, the intervertebral cage can be configured so that, in asecond position, the distal-most part of the front panel protrudes lessdistally from the circuitous body. In some embodiments, the system canalso include a deployment device configured to apply a force to convertthe intervertebral cage from the first position to the second position.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a perspective view of an embodiment of a verticallyexpandable intervertebral cage.

FIG. 2A illustrates a cross-sectional view, along line A-A, of theintervertebral cage of FIG. 1 in a first position.

FIG. 2B illustrates a cross-sectional view, along line A-A, of theintervertebral cage of FIG. 1 in a second position.

FIG. 2C illustrates a cross-sectional view, along line A-A, of theintervertebral cage of FIG. 1 in a third position.

FIG. 3A illustrates a side elevation view of the intervertebral cage ofFIG. 1 in a first position.

FIG. 3B illustrates a side elevation view of the intervertebral cage ofFIG. 1 in a second position.

FIG. 3C illustrates a side elevation view of the intervertebral cage ofFIG. 1 in a third position.

FIG. 4A illustrates a side elevation view of an embodiment of a hingeand locking mechanism in a first position.

FIG. 4B illustrates a side elevation view of the hinge and lockingmechanism of FIG. 4A in a second position.

FIG. 5A illustrates a side elevation view of a second embodiment of ahinge and locking mechanism in a first position.

FIG. 5B illustrates a side elevation view of the hinge and lockingmechanism of FIG. 5A in a second position.

FIG. 6A illustrates a side elevation view of a third embodiment of ahinge and locking mechanism in a first position.

FIG. 6B illustrates a side elevation view of the hinge and lockingmechanism of FIG. 6A in a second position.

FIG. 7 illustrates a partial cross-sectional view of one embodiment ofan implantation tool which can be used to convert an intervertebral cageapparatus from an undeployed position to a deployed position.

DETAILED DESCRIPTION

Embodiments are shown of a vertically expandable intervertebral cageconfigured for positioning between two vertebrae and specificallybetween two vertebral end plates. The vertically expandableintervertebral cage is configured to have at least two differentconfigurations. In a first or undeployed configuration, the apparatus isconfigured to have a reduced dimension in the vertical direction (i.e.,an axis perpendicular to the plane of a vertebral end plate) or areduced height which thereby facilitates the process of inserting theapparatus into the vertebral space during an implantation procedure. Ina second or deployed configuration, the apparatus is configured to havean increased dimension in the vertical dimension or an increased height.In this deployed configuration, the apparatus is configured to maintainspacing between the two vertebral end plates at a desired height.Embodiments of the device can have different vertical dimensions orheights based upon the application. The intervertebral cage as describedherein can be “space-agnostic” in the sense that it can be used formultiple spinal fusion techniques including transforaminal lumbarinterbody fusion (TLIF) and lateral lumbar interbody fusion (XLIF).

Intervertebral Cage

FIG. 1 is an illustration of an embodiment of the intervertebral cage100 in a deployed configuration. The intervertebral cage 100 has both afront panel 102 and a circuitous body 105. In a deployed configuration,front panel 102 is configured to provide structural support, in the formof a strut, for the cage 100. In one embodiment, the front panel 102includes a hinge 110 positioned equidistant from the top edge 112 andthe bottom edge 114 which subdivides the front panel 102 into both a topsection 116 a and a bottom section 116 b. In other embodiments, thehinge 110 may be placed closer to the top edge 112 or to the bottom edge114 depending upon the geometry desired in the undeployed and deployedconfigurations. Furthermore, in yet other embodiments, more than onehinge can be included on the front panel 102.

In some embodiments, the top section 116 a and the bottom section 116 bare separate units which are rotatably attached at hinge 110 to formfront panel 102. In those embodiments, rotatable attachment of the topand bottom sections 116 a, 116 b can be accomplished through attachmentmechanisms such as, but not limited to, pin-hinge assemblies, elasticadhesives, attachment to other materials allowing for elasticdeformation, or other hinging mechanisms used in the art. In anotherembodiment, the top section 116 a and the bottom section 116 b areintegral and form a single unit. In that embodiment, the hinge 110 isformed via a reduced thickness (i.e., a living hinge) of the front panel102 along the hinge 110 which is configured to allow deformation alonghinge 110.

In one embodiment, such as that illustrated in FIG. 1, the front panel102 has an aperture 118 substantially centered on the front panel 102.In other embodiments, the front panel 102 has multiple apertures locatedon both the top section 116 a and bottom section 116 b. Aperture 118 canbe configured to allow a distal part of an implantation device to enterthrough the trailing end 108 of the intervertebral cage 100 and passthrough aperture 118 such that the distal part of the implantationdevice is distal the front panel 102. In embodiments with multipleapertures on the top section 116 a and the bottom section 116 b, theapertures can be configured to allow a guide wire to be inserted throughthe trailing end 108 of the intervertebral cage 100 through a firstaperture and returned to the trailing end 108 through a second aperture.The implantation device or guide wire can be used to apply the force toconvert the intervertebral cage 100 from an undeployed configuration toa deployed configuration.

For example, as illustrated in FIG. 7, the distal part 702 of theimplantation device 700 can be used to engage the front surface of thefront panel 102 or an edge forming the aperture 118. A proximal part 704of the implantation device 700 can then be used to grasp a portion ofthe circuitous body 105. For example, the proximal part of theimplantation device 700 can engage the top panel 150 and the bottompanel 160 using clips, prongs or similar devices. The distal part 702can be movable relative to the proximal part 704. As shown in theillustrated embodiment, the distal part 702 can be formed on an innershaft 706 which is translatable within a lumen 708 of an outer shaft 710on which the proximal part 704 is formed. Accordingly, a user canmaintain the circuitous body 105 in position with the proximal part 704while retracting the distal part 702 proximally towards the user. In sodoing, the user can apply a force onto the front panel 102 towards thecircuitous body 105 to transition the intervertebral cage 100 from oneconfiguration to another. The user can also maintain the front panel 102in position with the distal part 702 while moving the proximal part 704distally away from the user. In so doing, the user can apply a forceonto the circuitous body 105 towards the front panel 102 to transitionthe intervertebral cage 100. It should be understood that the proximalpart 704 of the implantation device 702 can passively or dynamicallyalter in shape during the transition of the intervertebral cage 100 fromone configuration to another configuration. Accordingly, the shape ofthe proximal part can be altered to match the change in shape of theintervertebral cage 100 while the intervertebral cage 100 transitionsbetween configurations. For example, in some embodiments, the clips orprongs of the implantation device 700 can further separate toaccommodate the increase in separation between the top panel 150 and thebottom panel 160 as the intervertebral cage 100 transitions from anundeployed configuration to a deployed configuration.

As another example, after insertion of the guide wire into one or moreapertures, the guide wire can be retracted proximally relative to thecircuitous body 105 such that a proximally-directed force is applied tothe front panel 102. As yet another example, an inflatable device, suchas an inflatable bladder, can be placed within the interior volume 190.The inflatable device can be inflated such that the inflatable deviceincreases in volume within the interior volume 190. The inflatabledevice can contact portions of the intervertebral cage 100 such that aforce is applied on the intervertebral cage to deploy the cage 100. Suchmethods and devices are described in more detail in InternationalApplication No. PCT/US2013/056500 filed Aug. 23, 2013, the entirecontents of which is hereby incorporated by reference.

In the illustrated embodiment, the top and bottom sections 116 a, 116 bare generally of rectangular shape notwithstanding the aperture 118. Insuch a configuration, the top edge 112 and the bottom edge 114 generallyremain parallel. In other embodiments, the top and bottom sections arenot rectangular shaped but rather wedge shaped such that the top andbottom edges 112, 114 are not parallel. These embodiments can be usedwhen the two surfaces requiring support are oblique and differentheights are necessary. Other shapes may include quadrilaterals such as,but not limited to, squares, rectangles, parallelograms, and trapezoids.Shapes may also include polygons with more than four sides, partialellipses such as semi-circles, and any other shape as may be chosen byone of skill in the art.

FIG. 2A-2C are illustrations of a cross-sectional view, as defined inFIG. 1, of an embodiment of the intervertebral cage 100. FIGS. 2A-2Cadditionally illustrate the process by which the intervertebral cage 100is converted from the undeployed configuration to the deployedconfiguration. Three separate configurations are shown: the undeployedconfiguration (shown in FIG. 2A), an intermediate configuration (shownin FIG. 2B), and the deployed configuration (shown in FIG. 2C). Thecircuitous body 105 is comprised of a top panel 150, a bottom panel 160,and two side panels 170 and 180. Circuitous body 105 partially enclosesan interior volume 190.

In a deployed configuration, top panel 150 is configured to contact andsupport an end plate of the vertebrae. As such, in some embodiments ofthe device such as that illustrated in FIG. 1, the top panel 150 issubstantially flat. In other embodiments, the top panel 150 can beshaped to better conform to the end plate the panel is configured tocontact and support. In yet other embodiments, the top panel 150 mayadditionally include raised protrusions, ridges or spikes to provideadditional stability when the top panel 150 is placed adjacent to andcontacting the end plate. In the illustrated embodiment, the top panel150 includes a distal edge 152, a proximal edge 154, a first side edge156, and a second side edge 158. In other embodiments, the top panel 150can be non-rectangular and may include more than four sides. In suchembodiments, the cage 100 may have more than two side edges andpotentially no proximal edge 154. In other embodiments, the top panel150 may have one or more apertures configured to facilitate expansion ofthe cage, to receive bone graft material and/or to promote bone growthbetween adjacent vertebral bodies. The top panel 150 may also includeone or more screw holes configured to allow attachment of the top panel150 to the end plate.

In a deployed configuration, bottom panel 160 is configured to contactand support an end plate opposite the end plate supported by the toppanel 150. Bottom panel 160 is of similar construction to the top panel150 although, in some embodiments, the dimensions and shapes may differbased upon the shapes of the end plates the top and bottom panels 150,160 support. As such, in the illustrated embodiment, the bottom panelhas a distal edge 162, a proximal edge 164, a first side edge 156, and asecond side edge 158. The bottom panel 160 may also have raisedprotrusions, ridges or spikes on the surface contacting and supportingthe end plate to provide additional stability for the intervertebralcage 100. In other embodiments, the bottom panel 160 may have one ormore apertures configured to facilitate expansion of the cage, toreceive bone graft material and/or to promote bone growth betweenadjacent vertebral bodies. The bottom panel 160 may also include one ormore screw holes configured to allow attachment of the bottom panel 160to the end plate.

In a deployed configuration, side panels 170 and 180 are configured toprovide structural support, in the form of a strut, for the cage 100.Side panels 170 and 180 are generally of similar construction.Therefore, only side panel 170 will be described in detail with theunderstanding that side panel 180 can incorporate the same features andembodiments described with respect to side panel 170. It should be notedthat, like the top and bottom panels 150, 160, in some embodiments theside panels 170, 180 are of different sizes and shape. In oneembodiment, the side panel 170 includes a hinge 172 positionedequidistant from the top edge 174 and the bottom edge 176 whichsubdivides the side panel 170 into both a top section 178 a and a bottomsection 178 b. In other embodiments, the hinge 172 may be placed closerto the top edge 112 or the bottom edge 114 depending upon the geometrydesired when in an undeployed configuration or deployed configuration.Furthermore, in yet other embodiments, more than one hinge can beincluded on the side panel 170.

In some embodiments, the top section 178 a and the bottom section 178 bare separate units which are rotatably attached at hinge 172 to formside panel 170. In those embodiments, rotatable attachment of the topand bottom sections 116 a, 116 b can be accomplished through attachmentmechanisms such as, but not limited to, pin-hinge assemblies, elasticadhesives, attachment to other materials allowing for elasticdeformation, or other hinging mechanisms used in the art. In anotherembodiment, the top section 178 a and the bottom section 178 b areintegral and form a single unit. In that embodiment, the hinge 172 isformed via a reduced thickness of the side panel 170 along the hinge 172which is configured to allow for plastic deformation along hinge 172. Insome embodiments, such as the embodiment illustrated in FIG. 1, the sidepanel 170 is solid and therefore includes no apertures unlike the frontpanel 102. In other embodiments, the side panel 170 may include one ormore apertures. Such apertures may provide a lighter weightintervertebral cage 100 and may also be configured to provide foradditional deformation thus changing the support strength along parts ofthe side panel 170. Additionally, such apertures may also be configuredto facilitate expansion of the cage, to receive bone graft materialand/or to promote bone growth between adjacent vertebral bodies.

In the illustrated embodiment, the top and bottom sections 178 a, 178 bare generally rectangular. In such a configuration, the top edge 172 andthe bottom edge 174 are parallel. In other embodiments, it may beadvantageous to provide sections 178 a, 178 b in shapes other thanrectangles. As one non-limiting example, the top section 178 a andbottom section 178 b can be wedge shaped such that the verticaldimension at the leading end 106 of the sections is less than thevertical dimension at the trailing end 108 of the sections andvice-versa. As such, in embodiments where the opposite side panel 180has the same shape, the intervertebral cage 100 can have a wedge shapewhich may be more advantageous in situations where the two endplates tobe supported are oblique rather than parallel. Other potential shapesmay include quadrilaterals such as, but not limited to, squares,rectangles, parallelograms, and trapezoids. Shapes may also includepolygons with more than four sides, partial ellipses such assemi-circles, and any other shape as may be chosen by one of skill inthe art.

With reference to FIG. 1, front panel 102 is connected to the circuitousbody 105. The top edge 112 of the front panel 102 is rotatably attachedto the distal edge 152 of the top plate 150 and the bottom edge 114 ofthe front panel 102 is rotatably attached to the distal edge 162 of thebottom plate 160 thereby forming hinges along these edges. As such, insome embodiments, the front panel 102 may be a separate unit from thetop panel 150 and the bottom panel 160. In those embodiments, the frontpanel 102 is rotatably attached to the panels 150, 160 via mechanismssuch as, but not limited to, pin-hinge assemblies, elastic adhesives,attachment to other materials allowing for elastic deformation, or otherhinging mechanisms used in the art. In other embodiments, the frontpanel 102 may be a single, integral unit with either the top panel 150,the bottom panel 160, or both. In such embodiments, the hinge betweenthe integral unit may be a living hinge. Furthermore, in suchembodiments where the integral unit is separate from the top or bottompanels 150, 160, the hinge between the integral unit and the separateunit may be any of the attachment mechanisms described above.

With reference to FIGS. 2A-2C, side panel 170 is connected to the toppanel 150 and the bottom panel 160. The top edge 174 of the side panel170 is rotatably attached to the first side edge 156 of the top plate150 and the bottom edge 176 of the side panel 170 is rotatably attachedto the first side edge 166 of the bottom plate 160 thereby forminghinges along these edges. In some embodiments, the side panel 170 may bea separate unit from the top panel 150 and the bottom panel 160. Inthose embodiments, the side panel 170 is rotatably attached to thepanels 150, 160 via mechanisms such as, but not limited to, pin-hingeassemblies, elastic adhesives, attachment to other materials allowingfor elastic deformation, or other hinging mechanisms used in the art. Inother embodiments, the side panel 170 may be a single, integral unitwith either the top panel 150, the bottom panel 160, or both. In suchembodiments, the hinge between the integral unit may be a living hinge.Furthermore, in such embodiments where the integral unit is separatefrom the top or bottom panels 150, 160, the hinge between the integralunit and the separate unit may be any of the attachment mechanismsdescribed above.

The connection between side panel 180 and the top and bottom panels 150,160 is similar to that of the side panel 170. The top edge 184 of theside panel 180 is rotatably attached to the second side edge 158 of thetop plate 150 and the bottom edge 186 of the side panel 180 is rotatablyattached to the second side edge 168 of the bottom plate 160 therebyforming hinges along these edges. In some embodiments, the side panel180 may be a separate unit from the top panel 150 and the bottom panel160. In those embodiments, the side panel 180 is rotatably attached tothe panels 150, 160 via mechanisms such as, but not limited to,pin-hinge assemblies, elastic adhesives, attachment to other materialsallowing for elastic deformation, or other hinging mechanisms used inthe art. In other embodiments, the side panel 180 may be a single,integral unit with either the top panel 150, the bottom panel 160, orboth. In such embodiments, the hinge between the integral unit may be aliving hinge. Furthermore, in such embodiments where the integral unitis separate from the top or bottom panels 150, 160, the hinge betweenthe integral unit and the separate unit may be any of the attachmentmechanisms described above.

Therefore, it should be apparent to one of skill in the art that thepanels of the intervertebral cage 100 could form integral units withadjacent panels through the use of a living hinge or could be separatefrom adjacent units and rotatably attached via attachment mechanismsdescribed above. In some embodiments of the device, both living hingesand other attachment mechanisms are simultaneously used. This couldallow the device to be assembled post-manufacturing and potentiallyprovide cost savings. In other embodiments, living hinges are usedthroughout the entire device. This could allow the device to have a morecompact profile while in the undeployed state. In yet other embodiments,no living hinges are used. In such embodiments, all pieces could bemanufactured separately and allow for a user of the cage 100 to mixdifferent panel shapes and sizes together to obtain a desired shape andsize.

In one embodiment, the panels of the intervertebral cage 100 aremanufactured from polyetheretherketone (PEEK) or similar biomaterialshaving shape memory characteristics. In other embodiments, the panelsare manufactured from other materials such as, but not limited to,metals including titanium, stainless steel, nitinol, and pyroliticcarbon, medical grade polymers such as PEEK and silicone, and otherbiocompatible materials known in the art. In yet other embodiments, thepanels may be manufactured from different types of materials. As onenon-limiting example, the front panel 102 and side panels 170, 180 maybe manufactured from a metal such as titanium to provide a lightweightyet rigid support structure while the top and bottom panels 150, 160 maybe manufactured from PEEK or other types of materials which may betterconform to and support the end plates. The types of materials used forthe separate panels may be mixed to obtain the desired structural andperformance characteristics of the device.

Operation

As discussed above, the panels and sections of the intervertebral cage100 are rotatably attached to adjacent panels and sections. As such, theseparate panels of the intervertebral cage 100 can rotate from anundeployed configuration to a deployed configuration. The process ofconverting from the undeployed configuration to a deployed configurationof one embodiment of the intervertebral cage 100 is illustrated in FIGS.2A-2C and 3A-3C.

FIGS. 3A-3C is a view from the left side of the intervertebral cage 100which illustrates one non-limiting method of converting theintervertebral cage 100 from an undeployed configuration to a deployedconfiguration. Three separate configurations are shown: the undeployedconfiguration (shown in FIG. 3A), an intermediate configuration (shownin FIG. 3B), and the deployed configuration (shown in FIG. 3C).

With reference to FIG. 3A, while in the undeployed configuration, thefront panel 102 is collapsed such that top section 116 a and bottomsection 116 b form the sides of a wedge with hinge 110 forming the tipof the wedge. In this embodiment, the hinge 110 extends outwardly in adistal direction thereby providing the intervertebral cage 100 with awedge-shaped or tapered leading end 106. During an implantationprocedure, since the front panel 102 is the initial portion of theintervertebral cage 100 that enters the surgical site and the vertebralspace, this wedge-shaped or tapered configuration facilitates insertionof the intervertebral cage 100 into the patient during an implantationprocedure. First, because of the wedge shape, the user is assisted incentering the cage 100 within the space formed by the two vertebral endplates as the user advances the cage 100 into this space. Second, sincethe intervertebral cage 100 is at a reduced height in the undeployedconfiguration, there is a reduced likelihood that portions of the cage100, such as the top and/or bottom panels 150, 160, will contact the endplates thereby hindering advancement of the cage 100 during theprocedure.

With reference to FIG. 2A, while in the undeployed configuration, theside panels 170, 180 are collapsed inwardly such that they extend intothe interior volume 190 of the circuitous body 105. Collapsing inwardlyprovides the advantage of minimizing the width of the cage 100 during animplantation procedure thereby potentially reducing the size of thesurgical site and the overall invasiveness of the procedure. A reducedwidth also provides the benefit of reducing the likelihood that the sidepanels 170 and 180 will contact other parts of the spinal column duringthe implantation procedure. As such, the reduced width facilitatesmaneuvering the device around to the desired placement area. In otherembodiments, the side panels 160, 170 extend outwardly away from theinterior volume 190 when in the undeployed configuration. Extendingoutwardly provides the potential advantage of allowing a further reducedvertical dimension of the cage 100 while in the undeployedconfiguration.

In some embodiments, conversion the device from the undeployedconfiguration to the deployed configuration can be performed by applyinga force 300, in the direction of the trailing edge 108, to the frontpanel 102. This can be accomplished by pulling the front panel 102 whileinhibiting any translation of the device in a plane parallel to thevertebral end plates (i.e., by applying, for example, a counter-force onthe top and bottom plates 150, 160). Due to both the force on the frontpanel 102 and the rotatable attachment of the top and bottom sections116 a, 116 b, the hinge 110 is pulled towards the trailing end 108. Thismotion increases the angle formed between the top section 116 a and thebottom section 116 b thereby causing a vertical expansion of the cage100. An illustration of the movement of the front panel 102 and top andbottom panels 150, 160 can be observed in FIGS. 3A-3C. Because the sidepanels 160, 170 are rotatably attached to the top and bottom panels 150,160, the side panels 160, 170 are forced to rotate outwardly and awayfrom the interior volume 190. An illustration of the movement of theside panels 170, 180 and top and bottom panels 150, 160 can be observedin FIGS. 2A-2C.

Note that the cage 100 can also be opened using other methods. As onenon-limiting example, a force can instead be placed on the circuitousbody 105 towards the leading end 106 while inhibiting the front panel102, or more specifically the hinge 110, from translating in the samedirection. As a second non-limiting example, the forces may instead beapplied to the side panels 160, 170 in a direction opposite that inwhich they are collapsed. Thus, if collapsed inwardly towards theinterior volume 190, the separate forces can be applied on each sidepanel in a direction away from the interior volume 190. If collapsedoutwardly away from the interior volume 190, the separate forces can beapplied on each side panel in a direction towards the interior volume190. As a third non-limiting example, an upwards vertical force may beapplied to the bottom surface of the top panel 150 and a downwardsvertical force may be applied to the top surface of the bottom panel 160to commence the conversion process. Some or all of the methods describedabove can be combined together during the process of converting the cage100 from an undeployed configuration to a deployed configuration.

Hinge Mechanisms/Lock Mechanisms

In some embodiments, in order to reduce the likelihood that theintervertebral cage 100 will revert from the deployed configuration tothe undeployed configuration when already implanted, a locking mechanismis used.

In some embodiments, the locking mechanism is configured to reduce therange of motion of the hinges, such as, but not limited to, the hinges110, 162, and 172 of the front panel 102, side panel 160, and side panel170 respectively and is placed directly on the panel to reduceover-rotation of a rotatable panel. FIGS. 4A and 4B are illustrations ofone embodiment of a locking mechanism configured to reduce the range ofmotion of the hinges. In this embodiment, a protrusion 400 is placed onthe interior surface of one section 402 of the rotating panel. Uponbeing rotated to a desired angle, the protrusion 400 contacts theadjacent section 404 thereby providing resistance against additionalrotation in that direction. In some embodiments, the angle α is slightlygreater than 180° to reduce the likelihood that the device will rotatein the reverse direction and revert back to the undeployedconfiguration.

FIGS. 5A and 5B are illustrations of a second embodiment of a lockingmechanism configured to reduce the range of motion of the hinges. Inthis embodiment, there are two protrusions 500 and 502 located on innersurfaces of sections 504 and 506 of the rotating panel. The ends of theprotrusions are tapered such that, upon rotation of the rotating panel,the protrusions 500 and 502 are placed into contact along the taperedsurfaces thereby providing resistance against additional rotation inthat direction. Like the embodiment described above, in someembodiments, the angle α is slightly greater than 180° to reduce thelikelihood that the device will rotate in the reverse direction andrevert back to the undeployed configuration. The angle α can be chosenbased on the placement of the protrusions 500, 502 and the tapering ofthe edge.

In another embodiment, the hinges 110, 172, and 182 have additionalfasteners attached thereto. FIGS. 6A and 6B are illustrations of anembodiment of a fastener 600. A male portion 600 a of the fastener 600is placed on one section 602 and is configured to be inserted into afemale portion 600 b located on a second section 604 of the rotatablepanel 606. Upon being sufficiently rotated about the hinge 608, the maleportion 600 a is received in the female portion 600 b and, due to theshape of the fastener, provides resistance against being removed. Assuch, rotation in the opposite direction is reduced by virtue of thefastener 600. Note that, although these locking mechanisms werediscussed with respect to hinges 110, 172, and 182, these mechanisms mayalso be used for any other hinge located on the intervertebral cage 100.

In some embodiments, the range of motion of the hinges, such as, but notlimited to, the hinges 110, 162, and 172 of the front panel 102, sidepanel 160, and side panel 170 respectively is reduced by placing rigidclips connecting different panels and/or sections together. In yet otherembodiments, the range of motion of the hinges can be reduced byinserting an additional member into the interior volume 190 of thecircuitous body 105. In yet another embodiment, the range of motion ofthe hinges can be reduces through the use of screws.

In order to inhibit translation of the intervertebral cage 100 after ithas been inserted into and deployed within the vertebral space, otherfastening mechanisms can be used to attach the cage 100 to the endplates. In one embodiment, screws can be inserted through screw holeslocated on the top panel 150 and bottom panel 160 into the upper andlower vertebral bodies, respectively. Such screws may pass though screwholes that are angled upward and downward into the respective vertebralbodies from the rear of the intervertebral cage.

Optional Back Panel

Intervertebral cage 100 may additionally include a back panel to closethe trailing end 108 of the cage 100. In one embodiment, the back panelis configured to be inserted into the interior volume 190 of thecircuitous body 105. By being inserted into the circuitous body 105, theback panel provides additional support for the cage 100 and can servethe additional function of preventing the cage 100 from reverting fromthe deployed configuration to the undeployed configuration. In someembodiments, the back panel additionally comprises a spring elementwhich, when inserted into the interior volume 190, provides anadditional elastic support for the two intervertebral end plates.

In another embodiment, the back panel is attached directly to the toppanel 150 and the bottom panel 160 after the intervertebral cage 100 hasbeen deployed in the vertebral space. In such embodiments, the backpanel may be attached to the proximal edge 154 of the top panel 150 andthe proximal edge 164 of the bottom panel 160. The back panel may alsoadditionally be attached to the side panels 160 and 170 as an additionalmeans of reducing the range of motion of the hinges. In yet otherembodiments, the back panel may be initially rotatably attached toeither the proximal edge 154 or the proximal edge 164 prior to insertioninto the vertebral space. In such embodiments, upon deploying thevertebral cage 100, the back panel may be rotated about the edge towhich it is rotatably attached and additionally attach to the oppositeproximal edge.

In some embodiments, the back panel is of similar construction to thefront panel 102 and is initially attached to both the top panel 150 andthe bottom panel 160. In the above-mentioned embodiments, the back panelmay also include apertures configured to facilitate expansion of thecage, to receive bone graft material and/or to promote bone growthbetween adjacent vertebral bodies.

Although the methods and devices are described above with respect to ause within the intervertebral space for supporting two end plates, thedevice can be used with other portions of the body and in otherprocedures. Various modifications to the implementations described inthis disclosure may be readily apparent to those skilled in the art, andthe generic principles defined herein may be applied to otherimplementations without departing from the spirit or scope of thisdisclosure. Thus, the disclosure is not intended to be limited to theimplementations shown herein, but is to be accorded the widest scopeconsistent with the principles and features disclosed herein.

List of Embodiments

1. A vertically expandable intervertebral cage configured to be insertedbetween two vertebral endplates, comprising:

-   -   a circuitous body at least partially enclosing an interior        volume, the circuitous body comprising:        -   a top panel, having a distal edge and at least two side            edges;        -   a bottom panel, having a distal edge and at least two side            edges; and        -   at least two side panels, each having a top edge and a            bottom edge, wherein the side panel comprises at least one            hinge dividing the side panel into at least two side panel            sections;        -   wherein the top edges of the side panels are rotatably            attached to the side edges of the top panel along a hinge            and the bottom edges of the side panels are rotatably            attached to the side edges of the bottom panel along a            hinge; and    -   a front panel, having a top edge and a bottom edge, wherein the        front panel additionally comprises at least one hinge dividing        the front panel into at least two front panel sections;    -   wherein the top edge of the front panel is rotatably attached to        the distal edge of the top panel and the bottom edge of the        front panel is rotatably attached to the distal edge of the        bottom panel;    -   wherein, in a first position, the top panel and bottom panel are        separated by a first distance and the front panel forms a        leading wedge; and    -   wherein, in a second position, the top panel and bottom panel        are separated by a second distance, the second distance being        greater than the first distance.

2. The vertically expandable intervertebral cage of embodiment 1,wherein at least one of the hinges comprise a living hinge.

3. The vertically expandable intervertebral cage according to any ofembodiments 1 and 2, further comprising a locking mechanism configuredto reduce the range of motion of at least one hinge.

4. The vertically expandable intervertebral cage according to any ofembodiments 1-3, wherein the locking mechanism comprises a firstprotrusion along a surface of at least one of the panels.

5. The vertically expandable intervertebral cage of embodiment 4,further comprising a second protrusion along a surface of a panelattached to the panel comprising the first protrusion.

6. The vertically expandable intervertebral cage according to any ofembodiments 4 and 5, wherein the protrusion is positioned on an interiorsurface of the panel.

7. The vertically expandable intervertebral cage according to any ofembodiments 1-6, wherein the side panels extend into the interior volumewhen the intervertebral cage is in the first position.

8. The vertically expandable intervertebral cage according to any ofembodiments 1-6, wherein the side panels extend outwardly away from theinterior volume when the intervertebral cage is in the first position.

9. The vertically expandable intervertebral cage according to any ofembodiments 1-8, wherein, in the second position, the angle formed bythe side panel sections is greater than 180 degrees.

10. The vertically expandable intervertebral cage according to any ofembodiments 1-9, wherein, in the first position, the at least one hingeof the front panel forms a tip of a wedge

11. The vertically expandable intervertebral cage according to any ofembodiments 1-10, wherein at least one of the panels further comprise atleast one aperture.

12. The vertically expandable intervertebral cage of embodiment 11,wherein the front panel comprises an aperture.

13. The vertically expandable intervertebral cage of embodiment 11,wherein the front panel comprises two or more apertures.

14. The vertically expandable intervertebral cage according to any ofembodiments 1-13, further comprising a back panel for attachment to atrailing end of the intervertebral cage.

15. The vertically expandable intervertebral cage of embodiment 14,wherein the back panel is inserted into the interior volume.

16. The vertically expandable intervertebral cage of embodiment 14,wherein the back panel is attached to the top panel and the bottompanel.

17. The vertically expandable intervertebral cage according to any ofembodiments 1-13, wherein at least one panel comprisespolyetheretherketone (PEEK).

18. A vertically expandable intervertebral cage, comprising:

-   -   a circuitous body comprised of a plurality of panels partially        enclosing an interior volume, the plurality of panels comprising        at least a top panel, a bottom panel, and two side panels,        wherein each of the panels comprising the plurality of panels        are rotatably attached to adjacent panels along hinges; and    -   a front panel comprising a first front panel section rotatably        attached to a second front panel section, the front panel being        rotatably attached to at least two panels of the plurality of        panels of the circuitous body;    -   wherein, in a first position, a distal-most part of the front        panel protrudes distally from the circuitous body, and    -   wherein, in a second position, the distal-most part of the front        panel protrudes less distally from the circuitous body.

19. The vertically expandable intervertebral cage of embodiment 18,wherein:

-   -   in the first position, a first angle is formed between the first        front panel section and the second front panel section, and    -   in the second position, a second angle is formed between the        first front panel section and the second front panel section,        the second angle being greater than the first angle.

20. The vertically expandable intervertebral cage according to any ofembodiments 18 and 19, wherein the front panel forms a leading wedgewhile the cage is in the first position.

21. The vertically expandable intervertebral cage according to any ofembodiments 18-20, the two side panels each comprise a first side panelsection rotatably attached to a second side panel section.

22. The vertically expandable intervertebral cage of embodiment 21,wherein the side panels expand outwardly from the interior volume whenthe intervertebral cage is transitioned from the first position to thesecond position.

23. The vertically expandable intervertebral cage of embodiment 22,wherein, in the second position, the angle formed by the side panelsections is greater than 180 degrees.

24. The vertically expandable intervertebral cage of embodiment 21,wherein the side panels expand inwardly towards the interior volume whenthe intervertebral cage is transitioned from the first position to thesecond position.

25. The vertically expandable intervertebral cage according to any ofembodiments 18-24, wherein at least one of the panels further compriseat least one aperture.

26. The vertically expandable intervertebral cage of embodiment 25,wherein the front panel comprises an aperture.

27. The vertically expandable intervertebral cage of embodiment 25,wherein the front panel comprises two or more apertures.

28. The vertically expandable intervertebral cage according to any ofembodiments 18-27, wherein at least one panel comprisespolyetheretherketone (PEEK).

29. A method of deploying an intervertebral cage within anintervertebral disc space, the method comprising:

-   -   positioning the intervertebral cage in the intervertebral disc        space, wherein the intervertebral cage is configured to be moved        from a first position to a second position and wherein the        intervertebral cage comprises a circuitous body and a front        panel;    -   forming a wedge with the front panel; and    -   applying a force on one or more panels of the intervertebral        cage,    -   wherein the circuitous body comprises a plurality of panels.

30. The method of embodiment 29, wherein the step of applying a forcecomprises applying a force, in the direction of a trailing edge of theintervertebral cage, to the front panel.

31. The method of embodiment 30, wherein the step of applying a force tothe front panel further comprises inhibiting translation of circuitousbody.

32. The method of embodiment 29, wherein the step of applying a forcecomprises applying a force on the circuitous body towards a leading edgeof the intervertebral cage.

33. The method of embodiment 32, wherein the step of applying a force tothe circuitous body comprises inhibiting translation of circuitous body.

34. The method of embodiment 29, wherein the step of applying a forcecomprises applying a force on a surface of one or panels in theplurality of panels of the circuitous body.

35. A intervertebral cage system comprising:

-   -   an intervertebral cage comprising:        -   a circuitous body comprised of a plurality of panels            partially enclosing an interior volume, the plurality of            panels comprising at least a top panel, a bottom panel, and            two side panels, wherein each of the panels comprising the            plurality of panels are rotatably attached to adjacent            panels along hinges; and        -   a front panel comprising a first front panel section            rotatably attached to a second front panel section, the            front panel being rotatably attached to at least two panels            of the plurality of panels of the circuitous body;        -   wherein, in a first position, a distal-most part of the            front panel protrudes distally from the circuitous body, and        -   wherein, in a second position, the distal-most part of the            front panel protrudes less distally from the circuitous            body; and    -   a deployment device configured to apply a force to convert the        intervertebral cage from the first position to the second        position.

36. The system of embodiment 35, wherein:

-   -   in the first position, a first angle is formed between the first        front panel section and the second front panel section, and    -   in the second position, a second angle is formed between the        first front panel section and the second front panel section,        the second angle being greater than the first angle.

37. The system according to any of embodiments 35 and 36, wherein thefront panel forms a leading wedge while the cage is in the firstposition.

38. The system according to any of embodiments 35-37, the two sidepanels each comprise a first side panel section rotatably attached to asecond side panel section.

39. The system of embodiment 38, wherein the side panels expandoutwardly from the interior volume when the intervertebral cage istransitioned from the first position to the second position.

40. The system of embodiment 39, wherein, in the second position, theangle formed by the side panel sections is greater than 180 degrees.

41. The system of embodiment 38, wherein the side panels expand inwardlytowards the interior volume when the intervertebral cage is transitionedfrom the first position to the second position.

42. The system according to any of embodiments 35-41, wherein at leastone of the panels further comprise at least one aperture.

43. The system of embodiment 42, wherein the front panel comprises anaperture.

44. The system of embodiment 42, wherein the front panel comprises twoor more apertures.

45. The system according to any of embodiments 35-44, wherein at leastone panel comprises polyetheretherketone (PEEK).

46. The system according any of embodiments 35-44, wherein thedeployment device comprises an implantation device.

47. The system according to any of embodiments 35-44, wherein thedeployment device comprises a guide wire.

What is claimed is:
 1. A vertically expandable intervertebral cageconfigured to be inserted between two vertebral endplates, comprising: abody at least partially enclosing an interior volume, the bodycomprising: a top panel having a distal edge, a proximal edge and atleast two side edges; a bottom panel having a distal edge, a proximaledge and at least two side edges, wherein the distal edges of the topand bottom panels both lie within a front plane; at least two integralside panels, each having a top edge and a bottom edge, wherein the sidepanel comprises a living hinge dividing the side panel into a top sidesection and a bottom side section, the top and bottom edges of the sidepanels being rotatably attached to the side edges of the top and bottompanels along a living hinge; an integral front panel, having a top edgeand a bottom edge, wherein the front panel comprises a living hingedividing the front panel into a top front panel section and a bottomfront panel section, the top and bottom edges of the front panel beingrotatably attached to the distal edges of the top and bottom panelsalong a living hinge; an integral back panel, having a top edge and abottom edge, wherein the back panel comprises a living hinge dividingthe back panel into a top back panel section and a bottom back panelsection, the top and bottom edges of the back panel being rotatablyattached to the proximal edges of the top and bottom panels along aliving hinge; wherein, in a first position, the top panel and bottompanel are separated by a first distance and the living hinge of the topand bottom front panel sections of the front panel extends away from thefront plane and forms a leading wedge; and wherein, in a secondposition, the top panel and bottom panel are separated by a seconddistance, the second distance being greater than the first distance. 2.The vertically expandable intervertebral cage of claim 1, wherein thetop and bottom back sections of the side panels and back panel extendinto the interior volume when the intervertebral cage is in the firstposition.
 3. The vertically expandable intervertebral cage of claim 1,wherein the top and bottom back sections of the side panels and backpanel extend outwardly away from the interior volume when theintervertebral cage is in the first position.
 4. The verticallyexpandable intervertebral cage of claim 1, wherein the front panelcomprises at least one aperture.
 5. The vertically expandableintervertebral cage of claim 1, wherein the back panel comprises atleast one aperture.
 6. The vertically expandable intervertebral cage ofclaim 1, wherein the top patent and/or bottom panel includes raisedprotrusions, ridges or spikes configured to provide additional stabilitywhen the panels are placed adjacent to and contacting the vertebralendplates.
 7. The vertically expandable intervertebral cage of claim 1,wherein the top and/or bottom panels are configured to be shaped toconform to the vertebral endplates the panel is configured to contactand support.
 8. The vertically expandable intervertebral cage of claim1, wherein the top and bottom panels include one or more screw holesconfigured to allow attachment of the top and bottom panels to the twovertebral endplates.
 9. The vertically expandable intervertebral cage ofclaim 1, further comprising an implantation device having a distal partconfigured to engage the front panel and a proximal part configured tograsp a portion of the body, the implantation device being configured toapply a force to transition the intervertebral cage from first positionto the second position.
 10. The vertically expandable intervertebralcage of claim 1, further comprising a guide wire configured to engagethe front panel and retracted proximally relative to the body such thata proximally-directed force is applied to the front panel to convert theintervertebral cage from first position to the second position.
 11. Thevertically expandable intervertebral cage of claim 1, further comprisingan inflatable device configured to be placed within the interior volumebe inflated to apply a force to convert the intervertebral cage from thefirst position to the second position.
 12. A vertically expandableintervertebral cage, comprising: a body comprised of a plurality ofpanels partially enclosing an interior volume, the plurality of panelscomprising at least a top panel having a distal edge, a bottom panelhaving a distal edge, wherein the distal edges of the top and bottompanels both lie within a front plane, and two integral side panels,wherein each of the side panels comprising top and bottom side sectionsrotatably attached to adjacent panels along living hinges; and anintegral front panel comprising a top front panel section rotatablyattached by a living hinge to a bottom front panel section, the frontpanel being rotatably attached by living hinges to at least two panelsof the plurality of panels of the body; an integral back panelcomprising a top back panel section rotatably attached by a living hingeto a bottom back panel section, the back panel being rotatably attachedby living hinges to at least two panels of the plurality of panels ofthe body; wherein, in a first position, the living hinge of the frontpanel extends away from the front plane forming a wedge, and wherein, ina second position, the living hinge of the front panel extends away lessfrom the front plane.
 13. The vertically expandable intervertebral cageof claim 12, wherein the top and bottom back sections of the side panelsand back panel extend into the interior volume when the intervertebralcage is in the first position.
 14. The vertically expandableintervertebral cage of claim 12, wherein the top and bottom backsections of the side panels and back panel extend outwardly away fromthe interior volume when the intervertebral cage is in the firstposition.
 15. The vertically expandable intervertebral cage of claim 12,further comprising an implantation device having a distal partconfigured to engage the front panel and a proximal part configured tograsp a portion of the body, the implantation device being configured toapply a force to transition the intervertebral cage from first positionto the second position.
 16. The vertically expandable intervertebralcage of claim 12, further comprising a locking mechanism configured toreduce the range of motion of at least one hinge.
 17. A method ofvertically deploying an intervertebral cage within an intervertebraldisc space, the method comprising: positioning the intervertebral cagein the intervertebral disc space, wherein the intervertebral cage isconfigured to be moved from a first position to a second position andwherein the intervertebral cage comprises a body at least partiallyenclosing an interior volume, the body comprising; a top panel, having adistal edge and at least two side edges; a bottom panel, having a distaledge and at least two side edges, wherein the distal edges of the topand bottom panels both lie within a front plane; and at least twointegral side panels, each having a top edge and a bottom edge, whereinthe side panel comprises at least one a living hinge dividing the sidepanel into a top side section and a bottom side section; and an integralfront panel, having a top edge and a bottom edge, wherein the frontpanel additionally comprises a living hinge dividing the front panelinto a top front panel section and a bottom front panel section; anintegral back panel, having a top edge and a bottom edge, wherein theback panel additionally comprises a living hinge dividing the back panelinto a top front panel section and a bottom front panel section;wherein, in a first position, the living hinge of the front panelextends away from the front plane forming a wedge, and wherein, in asecond position, the living hinge of the front panel extends away lessfrom the front plane; applying a force on one or more panels of theintervertebral cage, and vertically expanding the intervertebral cagewithin the intervertebral disc space from the first position to thesecond position, wherein, in the first position, the top panel andbottom panel are separated by a first distance, and in the secondposition, the top panel and bottom panel are separated by a seconddistance, the second distance being greater than the first distance. 18.The method of claim 17, wherein applying a force on one or more panelsof the intervertebral cage incudes an implantation device having adistal part configured to engage the front panel and a proximal partconfigured to grasp a portion of the body, the implantation device beingconfigured to apply the force to transition the intervertebral cage fromfirst position to the second position.
 19. The method of claim 17,further comprising shaping the top and/or bottom panels to conform tovertebral endplates the panel is configured to contact and support. 20.The method of claim 17, wherein the body further includes a lockingmechanism, and the method further comprises locking the body in thesecond position.